Case study 8 - acute stress disorder and adjustment disorder

Introduction

The claimant was driving with their pregnant partner as a passenger. They were travelling at approximately 80km per hour along a main road when two vehicles in front of them suddenly collided. This caused the claimant to brake suddenly. The rear of the claimant’s vehicle was impacted by another car. Airbags did not deploy. The claimant’s vehicle was badly dented but drivable.

The claimant became concerned for their partner and unborn child. They drove to hospital from the scene of the accident.

The claimant was not assessed at hospital, however his partner was assessed and monitored in the maternity ward.

Upon returning home, the claimant was unable to sleep. Overnight, severe pain developed in the lower back, neck, pelvis and ankle. The following day the claimant attended a general practitioner. The claimant was prescribed analgesic medication and referred to a physiotherapist for treatment.

The claimant experienced symptoms of acute psychological distress involving fear of serious injury to their partner and baby at the time of the accident and persisting thereafter. There has been no referral to a psychiatrist and no suggestion of treatment with medication.

The Psychological Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).

Pre-MVA

No history of psychiatric illness

Sufficient performance at work

Enjoyed socialising and spending time with friends

Interested in sports and technology

Able to drive independently

Would regularly shop for groceries and cook meals

During Assessment

Intrusive distressing memories of the traumatic event both in dreams and whilst awake

Heightened arousal with irritability and escalation to anger as an indication of physiological reaction to the subject accident

Avoidant behaviour including limited enthusiasm for driving and heightened fear whilst on the road in traffic

Emotional numbing and detachment from those who are close, especially within the family setting

Difficulty with concentration

Disturbed appetite

Insomnia

Feelings of guilt and self-blame associated for the role as driver in the accident

Deteriorated performance at work regarding thinking, organising and completing tasks

Recurrent thoughts of death and suicidal ideation in the absence of a specific plan or intent

Depressed mood that is persistent for most of the day

Significant diminished interest in virtually all activities

The duration of the claimant’s illness has persisted since the time of the subject accident. It causes significant disturbance and impairment in social, occupational and recreational activities.

Review of Documentation

Material from treating psychologist records pre-accident capacity and compares this with reduced capacity in a number of domains following the subject accident (e.g work, home and community). The stated goals describe effective management of worry and anxiety, to facilitate a return to the previous level of social and recreational functioning. A diagnosis of Adjustment Disorder with mixed anxiety and depressed mood was provided.

Diagnosis

The claimant has significant psychiatric illness and symptoms consistent with a diagnosis of Posttraumatic Stress Disorder as per DSM 5 criteria.

In addition, the claimant’s mood disturbance is in excess of the disturbed mood identified with Posttraumatic Stress Disorder. The extent of his mood disturbance warranted a diagnosis of Major Depressive Disorder consistent with the diagnostic criteria of DSM 5.

Minor Injury

Section 1.6(3) of the Act:

A minor psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.

Part 1 clause 4 (2) of the Motor Vehicle Injuries Regulation 2017:

2) Each of the following injuries is included as a minor psychological or psychiatric injury

a) acute stress disorder

b) adjustment disorder

3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical manual of Mental Disorders (DSM-5).

The injuries assessed do not meet the description of a minor psychological or psychiatric injury.